Healthcare Provider Details

I. General information

NPI: 1316231517
Provider Name (Legal Business Name): CLINT FIELD BURRUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2011
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S KING ST
SEGUIN TX
78155-5838
US

IV. Provider business mailing address

1215 E COURT ST
SEGUIN TX
78155-5129
US

V. Phone/Fax

Practice location:
  • Phone: 830-372-2791
  • Fax: 830-386-0241
Mailing address:
  • Phone: 830-401-7558
  • Fax: 830-401-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberQ3858
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberQ3858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: